Department of Otorhinolaryngology of the Virgen Macarena University Hospital.
Department of Nursing University of Seville.
Otol Neurotol. 2024 Aug 1;45(7):717-731. doi: 10.1097/MAO.0000000000004225. Epub 2024 Jun 18.
To determine the cost-effectiveness or cost-utility of cochlear implants (CI) in adults with severe to profound bilateral hearing loss.
PubMed (Medline), The Cochrane Library, Embase via Elsevier, EBSCOhost CINAHL, and Scopus.
The study included adult participants with severe to profound bilateral neurosensory hearing loss. The analysis encompassed quality of life improvements, costs, cost-effectiveness, cost-utility, cost-benefit, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Systematic reviews, meta-analyses, case series, and prospective or retrospective cohort studies published in English between 2010 and 2023 were retrieved. Exclusion criteria included incomplete studies, abstracts, clinical cases, editorials, letters, studies involving pediatric populations, single-side deafness, methodology research, noneconomic aspects of CI, mixed child and adult data, and studies published before 2010. The risk of bias was assessed following the criteria outlined in Appendix I of the economic evaluation's quality assessment as per the NICE Guideline Development Method.
Ten articles met the criteria and were included in the qualitative synthesis. One study conducted a prospective cost-utility analyses, one carried out a cost-benefit analyses, one was a randomized controlled clinical trial focusing on cost-utility, and another was a clinical trial addressing cost-effectiveness. Six studies employed Markov models, and one study utilized uniquely the Monte Carlo method. None quantified the economic impact of improved hearing on cognitive function.
The heterogeneity of sources impacted data quality. Unilateral and sequential bilateral CI appeared to be cost-effective when compared with bilateral hearing aids or nontechnological support. When properly indicated, simultaneous bilateral CIs are cost-effective compared to no interventions and to unilateral cochlear implantation through differential discounting or variations from the base cases, especially with a life expectancy of 5-10 years or longer.
评估成人重度至极重度双侧感音神经性听力损失患者使用人工耳蜗植入（CI）的成本效益或成本效用。
PubMed（Medline）、Cochrane 图书馆、Elsevier 的 Embase、EBSCOhost CINAHL 和 Scopus。
本研究纳入了重度至极重度双侧感音神经性听力损失的成年参与者。分析包括生活质量改善、成本、成本效益、成本效用、成本效益比、质量调整生命年（QALY）、增量成本效益比（ICER）和增量成本效用比（ICUR）。检索了 2010 年至 2023 年间以英文发表的系统评价、meta 分析、病例系列和前瞻性或回顾性队列研究。排除标准包括研究不完整、摘要、临床病例、社论、信件、涉及儿科人群的研究、单侧耳聋、方法学研究、CI 的非经济方面、儿童和成人数据混合以及 2010 年前发表的研究。根据 NICE 指南制定方法中经济评估质量评估附录 I 中的标准评估偏倚风险。
符合标准并纳入定性综合分析的有 10 篇文章。一项研究进行了前瞻性成本效用分析，一项研究进行了成本效益分析，一项是关注成本效用的随机对照临床试验，另一项是针对成本效益的临床试验。六项研究使用了 Markov 模型，一项研究独特地使用了蒙特卡罗方法。没有研究量化听力改善对认知功能的经济影响。
来源的异质性影响了数据质量。与双侧助听器或非技术支持相比，单侧和序贯双侧 CI 似乎具有成本效益。在适当情况下，与无干预相比，同时双侧 CI 具有成本效益，与单侧耳蜗植入相比，通过差异贴现或偏离基础案例，尤其是预期寿命为 5-10 年或更长时间时，具有成本效益。
